Amino Acid: definition

What Is Multiple Sclerosis?

[dropcap]M ultiple sclerosis is an autoimmune disease of the central nervous system characterized by patchy inflammation of the myelin sheath surrounding nerve cells that produces multiple and varied neurologic symptoms and signs due to demyelination.

Q: What does demyelination mean.

A: Demyelination means there is damage to the myelin sheath which is a fatty substance that surrounds and protects nerve cells much like a the covering of a lamp cord keeps the electricity flowing within it from the plug to the light bulb. This damage impairs transmission of nerve impulses between the brain and body.

In the process of demyelination, T-lymphocyte cells that are activated and potentially autoimmune cross the blood-brain barrier and produce inflammatory plaques and axonal tissue loss in the brain, spinal cord or optic (vision) nerves. The end result is the accumulation of gliosis (scarring) and demyelination of areas in the central nervous system.¹

The course of multiple sclerosis is unpredictable and slowly progressive, usually with  exacerbations (worse symptoms) and remissions (relief of symptoms).

Multiple sclerosis affects about 1 ‰ of the population worldwide.

What Is Multiple Sclerosis In Celiac Disease and/or Gluten Sensitivity?

• Relationship between multiple sclerosis and celiac disease. Multiple sclerosis is an associated T-cell-mediated autoimmune disease in celiac disease, although research is conflicting. The association between celiac disease and other immune disorders may be due to the sharing of a common genetic background, such as HLA antigens. However, in a very large study, involving 909 patients with celiac disease, Ventura and his associates found that the development of immune disorders in celiac disease was clearly related to the duration of exposure to gluten.²
• Relationship between multiple sclerosis and diet response. Despite normal anti-gliadin, endomysial, and transglutaminase antibodies, celiac disease was diagnosed in a patient at age 41 years based upon the history, polyneuropathy, positivity for HLA-DQ2 and HLA-DQ8, the white matter lesions, and a beneficial response of the gastrointestinal problems and polyneuropathy to gluten-free diet. Celiac disease may mimic multiple sclerosis and may be present despite the absence of anti-gliadin, endomysial or transglutaminase antibodies. Celiac disease should be considered if there is a gastrointestinal problem, polyneuropathy, and ataxia, even if cerebral spinal fluid and MRI findings are suggestive of multiple sclerosis.³
• Relationship between multiple sclerosis and leaky gut. Tight junction dysfunction in increased intestinal permeability (leaky gut) has been shown to be a part of multiple sclerosis.⁴
• Relationship between multiple sclerosis and dysbiosis. Perhaps the greatest environmental risk factor associated with the development of immune-mediated conditions such as multiple sclerosis is the gut microbiome. Microbial and helminthic agents are active participants in shaping the immune systems of humans.  The clinical importance of these findings for multiple sclerosis is suggested by both their participation in disease and, perhaps of greater clinical importance, improvement of disease severity.⁵ That is, restoring healthy gut microbial populations improves health.
• Relationship between multiple sclerosis and vitamin D. It is well established that vitamin D plays an important role in the regulation of immune functions.  Several studies indicate that patients with multiple sclerosis have lower levels of vitamin D and that higher vitamin D levels as well as vitamin D supplementation have a protective effect against this disease. Moreover, vitamin D levels have been shown to vary in concordance with MS exacerbations.⁶
• Relationship between multiple sclerosis and vitamin B12. Of interest, cobalamin (vitamin B₁₂) deficiency can mimic multiple sclerosis and occurs with several disorders, involving different organs and systems, including blood, bowel, nervous system and eyes.⁷

How Prevalent Is Multiple Sclerosis In Celiac Disease and/or Gluten Sensitivity?

• A study investigating the prevalence of serological, histological and genetic celiac disease markers in a series of 72 multiple sclerosis (MS) patients and in their 126 first-degree relatives, compared to 123 healthy controls found an increased prevalence of celiac disease in 8 of the 72 MS patients (11.1%) and also in their first-degree relatives (23/126 [32%]). Tissue transglutaminase 2 (TGt-2) anti-IgA antibody count was the only marker used.¹
• A study screening for celiac disease in patients with multiple sclerosis using IgA anti-endomysial antibodies found prevalence of 2%, and a 12% rate using IgG anti-gliadin antibodies.⁸

What Are The Symptoms Of Multiple Sclerosis?

Multiple sclerosis is marked by varied symptoms:

• Muscular weakness.
• Numbness.
• Visual disturbances such as blurring.
• Pain or irritation of the eyes in some because of inflammation of the uveal tract (called uveitis) caused by autoimmune antibodies produced in multiple sclerosis.  The uveal tract located in the front of the eye has a rich supply of blood vessels.

How Does Multiple Sclerosis Develop In Celiac Disease and/or Gluten Sensitivity?

• Multiple sclerosis results from unclear etiology, but an immune mechanism is suspected based on certain HLA allotypes which are genetic markers.
• Omega-3 fatty acid deficiency is a risk factor.⁹
• Vitamin D insufficiency and antibiotic exposure contribute to the development of multiple sclerosis.⁵
• Dysbiosis.  Unhealthy gut microbes participate in the activity of multiple sclerosis and, perhaps of greater clinical importance, healthy gut microbes improve disease severity.⁵

Does Multiple Sclerosis Respond To Gluten-Free Diet?

Response of multiple sclerosis to gluten free diet varies.

Fish oil supplementation is highly effective in reducing the levels of inflammatory cytokines and nitric oxide catabolites in patients with relapsing-remitting multiple sclerosis.¹⁰

Vitamin D supplementation has a protective effect against this disease.¹¹

6 Steps To Improve Multiple Sclerosis In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1 Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition may respond to the complete elimination of gluten, which is the required treatment that improves both multiple sclerosis and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.¹²
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2  Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.¹³
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.¹³
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.¹³.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.¹³
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.¹³
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.¹³[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes green leafy vegetables such as lettuce and kale, also onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3  Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4  Manage Your Medications Safely:

[box type=”shadow” ]

Certain medications deplete vitamin D, omega-3 fatty acids, and gut microbes that promote multiple sclerosis. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below.

This is not a complete listing.

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac® deplete Vitamin D.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Vitamin D.

ANTIBIOTICS disrupt intestinal permeability which complicates celiac disease.

• Gentomycin, Neomycin, Streptomycin, Cephalosporins, Penicillins deplete Probiotics.
•  Tetracyclines deplete Probiotics.

ANTI-INFLAMMATORIES disrupt intestinal permeability which complicates celiac disease.

• Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) Vitamin D.

ANTICONVULSANTS

• Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Vitamin D.

CHOLESTEROL DRUGS

• Colestid® and Questran® deplete Vitamin D.

WEIGHT LOSS DRUGS THAT BIND FAT also interfere with absorption of some nutrients.

• Zenicol (Orlistat®) depletes Vitamin D.

 [/box]

• [dropcap]5 Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• Probiotics to restore gut microbe populations.
• Vitamin D3 as prescribed following blood test for status.
• Fish oil to obtain EPA/DHA fatty acids.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table. Fish oil goes in the refrigerator.[/box]

• [dropcap]6 Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Multiple Sclerosis In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“Efficacy of fish oil on serum of TNF α , IL-1 β , and IL-6 oxidative stress markers in multiple sclerosis treated with interferon beta-1b. ” This study investigating the efficacy of fish oil supplementation on serum proinflammatory cytokine levels, oxidative stress markers, and disease progression in multiple sclerosis found that fish oil supplementation is highly effective in reducing the levels of cytokines and nitric oxide catabolites in patients with relapsing-remitting multiple sclerosis.

50 patients with relapsing-remitting multiple sclerosis were enrolled. The experimental group received orally 4 g/day of fish oil for 12 months. The primary outcome was serum TNF α levels; secondary outcomes were IL-1 β 1b, IL-6, nitric oxide catabolites, lipoperoxides, progression on the expanded disability status scale (EDSS), and annualized relapses rate (ARR). Fish oil treatment decreased the serum levels of TNF α , IL-1 β , IL-6, and nitric oxide metabolites compared with placebo group (P ≤ 0.001). There was no significant difference in serum lipoperoxide levels during the study. No differences in EDSS and ARR were found.¹⁰

“Prevalence of celiac disease in multiple sclerosis.” This study investigating the prevalence of serological, histological and genetic celiac disease markers in a series of 72 multiple sclerosis (MS) patients and in their 126 first-degree relatives, compared to 123 healthy controls found an increased prevalence of celiac disease in 8 of the 72 MS patients (11.1%) and also in their first-degree relatives (23/126 [32%]). Therefore, increased efforts aimed at the early detection and dietary treatment of CD, among antibody-positive MS patients, are advisable.

Tissue IgA-anti-transglutaminase-2 antibodies were positive in 7 MS patients (10%), compared to 3 healthy controls (2.4%). No differences were found in HLA-DQ2 markers between MS patients (29%) and controls (26%) (NS).We detected mild or moderate villous atrophy (Marsh III type) in duodenal biopsies, in 8 MS patients (11.1%). A high proportion of celiac disease among first-degree relatives was found: 23/126 (32%). Several associated diseases were detected, mainly dermatitis 41 (57%) and iron deficiency anemia in 28 (39%) MS patients.Also, an increased frequency of circulating auto-antibodies such as anti-TPO in 19 (26%), ANA in 11 (15%) and AMA in 2 (3%) was found.¹

CASE REPORT SUMMARIES

“Celiac disease with cerebral and peripheral nerve involvement mimicking multiple sclerosis.” This case report describes diagnosis of celiac disease in a 43-year-old Caucasian male with a history of diarrhea and colics since age 3 months when wheat and milk were begun, progressive sensory disturbances developed since age 18 years. At age 34, he was diagnosed as relapsing-remitting multiple sclerosis upon an inflammatory CSF-syndrome and non-specific white matter lesions and treated with interferon beta-1b during the next 8 years without effect.

At age 35, axonal polyneuropathy and ataxia were diagnosed. Neurological exam revealed gaze-evoked nystagmus, brady diadochokinesis, intention ataxia on the left side, stocking type hypoesthesia on the lower limbs, absent tendon reflexes on the lower limbs, and ataxic stance and gait, this is why he used two crutches for walking. Standing without support resulted in a tendency to fall. Blood tests revealed elevated myoglobin, vitamin-B12 deficiency, and vitamin-D-deficiency, but no gliadin (endomysial) and transglutaminase autoantibodies were found.

Despite normal anti-gliadin, endomysial, and transglutaminase antibodies, celiac disease was diagnosed at age 41, based upon the history, polyneuropathy, positivity for HLA-DQ2 and HLA-DQ8, the white matter lesions, and a beneficial response of the gastrointestinal problems and polyneuropathy to gluten-free diet. Celiac disease may mimic multiple sclerosis and may be present despite the absence of anti-gliadin, endomysial or transglutaminase antibodies. Celiac disease should be considered if there is a gastrointestinal problem, polyneuropathy, and ataxia, even if CSF and MRI findings are suggestive of multiple sclerosis.³

“Multiple sclerosis-like neurological manifestations in a coeliac patient: nothing is as it seems.” This case report describes the case of a 48-year-old man, suffering from coeliac disease for approximately 5 years, who showed multiple sclerosis-like neurological manifestations. He was a vegetarian and was admitted to the neurology department, referring dysaesthesia of the left lower limb, decreased libido and erectile dysfunction. Vitamin B₁₂ deficiency was proved, even in the absence of blood count alteration, and treated with a vitamin supplement, resulting in complete remission.¹⁴

“Multiple sclerosis and occult gluten sensitivity. ” This case report describes the course of two atypical patients with a multiple sclerosis-like illness and evidence of occult celiac disease. This prompted screening of a further 49 unselected cases of multiiple sclerosis for serologic evidence of celiac disease. IgA anti-endomysial antibody was found in one case (2%). IgG anti-gliadin antibody was found in 12% of patients and 13% of blood donors.¹⁵

Sources:

1. Rodrigo L, Hernández-Lahoz C, Fuentes D, Alvarez N, López-Vázquez A, González S. Prevalence of celiac disease in multiple sclerosis. BMC Neurol. 2011 Mar 7;11:31. doi: 10.1186/1471-2377-11-31. [↩] [↩] [↩]
2. La Villa G, Pantaleo P, Tarquini R, Cirami L, Perfetto F, Mancuso F, Laffi G. Multiple immune disorders in unrecognized celiac disease: a case report. World J Gastroenterol. 2003;9(6):1377-1380. [↩]
3. Finsterer J, Leutmezer F. Celiac disease with cerebral and peripheral nerve involvement mimicking multiple sclerosis. J Med Life. 2014 Sep 15;7(3):440-4. [↩] [↩]
4. Fasano A. Zonulin and Its Regulation of Intestinal Barrier Function: The Biological Door to Inflammation, Autoimmunity, and Cancer. Physiological Reviews. January 2011. Vol. 91no. 151-175DOI: 10.1152/physrev.00003.2008 [↩]
5. Telesford K1, Ochoa-Repáraz J, Kasper LH.Gut commensalism, cytokines, and central nervous system demyelination. J Interferon Cytokine Res. 2014 Aug;34(8):605-14. doi: 10.1089/jir.2013.0134. [↩] [↩] [↩]
6. Wöbke TK, Sorg BL, Steinhilber D.Vitamin D in inflammatory diseases. Front Physiol. 2014 Jul 2;5:244. doi: 10.3389/fphys.2014.00244. eCollection 2014. [↩]
7. Mansueto P, Di Stefano L, D’Alcamo A, Carroccio A. Multiple sclerosis-like neurological manifestations in a coeliac patient: nothing is as it seems. BMJ Case Rep. 2012 Jul 4;2012. pii: bcr2012006392. doi: 10.1136/bcr-2012-006392. [↩]
8. Pengiran Tengah CD1, Lock RJ, Unsworth DJ, Wills AJ. Multiple sclerosis and occult gluten sensitivity. Neurology. 2004 Jun 22;62(12):2326-7. [↩]
9. Krause’s Food, Nutrition, & Diet Therapy. 10th Edition. Kathleen Mahan, Sylvia Escott-Stump. 2000. W.B. Saunders Company. [↩]
10. Ramirez-Ramirez V1, Macias-Islas MA, Ortiz GG, et al. Efficacy of fish oil on serum of TNF α , IL-1 β , and IL-6 oxidative stress markers in multiple sclerosis treated with interferon beta-1b. Oxid Med Cell Longev. 2013;2013:709493. doi: 10.1155/2013/709493. [↩] [↩]
11. Wöbke TK, Sorg BL, Steinhilber D.Vitamin D in inflammatory diseases. Front Physiol. 2014 Jul 2;5:244. doi: 10.3389/fphys.2014.00244. eCollection 2014. [↩]
12. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
13. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
14. Mansueto P, Di Stefano L, D’Alcamo A, Carroccio A. Multiple sclerosis-like neurological manifestations in a coeliac patient: nothing is as it seems. BMJ Case Rep. 2012 Jul 4;2012. pii: bcr2012006392. doi: 10.1136/bcr-2012-006392. [↩]
15. Pengiran Tengah CD1, Lock RJ, Unsworth DJ, Wills AJ. Multiple sclerosis and occult gluten sensitivity. Neurology. 2004 Jun 22;62(12):2326-7. [↩]